Earhart Gammon M, Duncan Ryan P, Huang John L, Perlmutter Joel S, Pickett Kristen A
Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.
Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
BMC Neurol. 2015 Feb 5;15:9. doi: 10.1186/s12883-015-0261-0.
Effective treatment of locomotor dysfunction in Parkinson disease (PD) is essential, as gait difficulty is an early and major contributor to disability. Exercise is recommended as an adjunct to traditional treatments for improving gait, balance, and quality of life. Among the exercise approaches known to improve walking, tango and treadmill training have recently emerged as two promising therapies for improving gait, disease severity and quality of life, yet these two interventions have not been directly compared to each other. Prior studies have been helpful in identifying interventions effective in improving gait function, but have done little to elucidate the neural mechanisms underlying functional improvements. The primary objective of the proposed work is to compare the effects of three community-based exercise programs, tango, treadmill training and stretching, on locomotor function in individuals with PD. In addition, we aim to determine whether and how these interventions alter functional connectivity of locomotor control networks in the brain.
METHODS/DESIGN: One hundred and twenty right-handed individuals with idiopathic PD who are at least 30 years of age will be assigned in successive waves to one of three community-based exercise groups: tango dancing, treadmill training or stretching (control). Each group will receive three months of exercise training with twice weekly one-hour group classes. Each participant will be evaluated at three time points: pre-intervention (baseline), post-intervention (3 months), and follow-up (6 months). All evaluations will include assessment of gait, balance, disease severity, and quality of life. Baseline and post-intervention evaluations will also include task-based functional magnetic resonance imaging (fMRI) and resting state functional connectivity MRI. All MRI and behavioral measures will be conducted with participants OFF anti-Parkinson medication, with behavioral measures also assessed ON medication.
This study will provide important insights regarding the effects of different modes of exercise on locomotor function in PD. The protocol is innovative because it: 1) uses group exercise approaches for all conditions including treadmill training, 2) directly compares tango to treadmill training and stretching, 3) tests participants OFF medication, and 4) utilizes two distinct neuroimaging approaches to explore mechanisms of the effects of exercise on the brain.
ClinicalTrials.gov NCT01768832 .
帕金森病（PD）运动功能障碍的有效治疗至关重要，因为步态困难是导致残疾的早期主要因素。建议将运动作为传统治疗的辅助手段，以改善步态、平衡和生活质量。在已知能改善步行的运动方法中，探戈和跑步机训练最近已成为改善步态、疾病严重程度和生活质量的两种有前景的疗法，但这两种干预措施尚未直接相互比较。先前的研究有助于确定有效改善步态功能的干预措施，但在阐明功能改善背后的神经机制方面做得很少。拟开展工作的主要目标是比较三种基于社区的运动项目，即探戈、跑步机训练和伸展运动，对帕金森病患者运动功能的影响。此外，我们旨在确定这些干预措施是否以及如何改变大脑中运动控制网络的功能连接。
方法/设计：120名年龄至少30岁的右利手特发性帕金森病患者将陆续被分配到三个基于社区的运动组之一：探戈舞蹈组、跑步机训练组或伸展运动组（对照组）。每个组将接受为期三个月的运动训练，每周两次，每次一小时的小组课程。每位参与者将在三个时间点进行评估：干预前（基线）、干预后（3个月）和随访（6个月）。所有评估将包括步态、平衡、疾病严重程度和生活质量的评估。基线和干预后评估还将包括基于任务的功能磁共振成像（fMRI）和静息态功能连接MRI。所有MRI和行为测量将在参与者停用抗帕金森药物的情况下进行，行为测量也将在用药时进行评估。
本研究将提供关于不同运动模式对帕金森病患者运动功能影响的重要见解。该方案具有创新性，因为它：1）对包括跑步机训练在内的所有情况都采用小组运动方法，2）直接将探戈与跑步机训练和伸展运动进行比较，3）在参与者停药的情况下进行测试，4）利用两种不同的神经影像学方法来探索运动对大脑影响的机制。
ClinicalTrials.gov NCT01768832 。
